High school has become an increasingly popular environment for implementing primary prevention and health promotion activities. In Ontario, for example, all Grade 9 students receive education in safety and violence prevention, substance abuse, and sexual health. However, the curriculum typically consists of untrained teachers showing videos and giving lectures on selected topics. Using an experimental design, the above-mentioned researchers attempted to test the effectiveness of a multi-method and multi-level primary prevention and skills promotion program, called The Fourth R. The main component of the intervention is a 21-lesson interactive curriculum (e.g., role playing, value clarification exercises) delivered by trained teachers. Other activities include guest speakers, field trips, theatre performances, awareness seminars for school staff, and attempts to inform/involve parents. Schools delivering the standard physical and health education program served as the control condition. A total of 22 schools (with 785 girls and 722 boys in Grade 9) were randomly assigned to control and experimental conditions.

Results showed that The Fourth R was well received by the students and substantial gains in knowledge about abuse, healthy sexuality, and substance use/abuse were reported over the course of the semester. Additionally, boys demonstrated greater awareness of relational aggression, and participated less in such acts. At post-test, The Fourth R did not have a discernible impact on levels of violent delinquency. However, the intervention appeared to diminish the link between childhood maltreatment and violent delinquency. Specifically, maltreated youth were more likely to be aggressive than were non-maltreated youth in schools receiving the control condition, but this association was not found among the sample receiving the experimental condition. The authors speculated that the program might help lessen the deleterious effects of maltreatment on youth problems such as aggression. An inspection of the program’s impact on maltreated youth is warranted.

In a hierarchical linear model (HLM) analysis, perceived safety at school emerged as a particularly robust predictor of violent delinquency. The authors assert: “school level safety was shown to influence youths’ delinquent behaviour” (p. 277; Crooks et al, 2007). However, it should be noted that other interpretations are possible. The presence of many violent delinquents in a school may have had a negative impact upon the climate of that environment, for example. Nevertheless, the finding is revealing and merits further study.

This effectiveness study had several strong features: randomized design, large sample size, a program that was pilot tested and grounded in theory, the use of process and outcome measures, an emphasis on developing a sustainable prevention strategy, and an attempt to implicate students, teachers, parents, and the community. The use of HLM to tease out individual and school level effects was particularly informative. There was, however, limited information on program adherence and whether any schools refused to participate. On the whole, The Fourth R project represents an important contribution to the field. Few outcome evaluations of school-based primary prevention programs have been conducted in such a thorough and systematic fashion. The results of the two-year follow-up study are eagerly awaited.